Treatment of BIMA Bypass Surgery

Introduction

Coronary artery disease (CAD) remains one of the leading causes of heart-related illness worldwide. When blockages in the coronary arteries restrict blood flow to the heart muscle, surgical intervention may become necessary. One of the most advanced and effective surgical techniques used today is BIMA – Bilateral Internal Mammary Artery grafting. This method is commonly used during Coronary Artery Bypass Grafting (CABG) and is known for its long-term success and durability.

What Is BIMA (Bilateral Internal Mammary Artery)?

BIMA stands for Bilateral Internal Mammary Artery, referring to the use of both the left and right internal mammary arteries as grafts during bypass surgery. These arteries are located inside the chest wall and naturally supply blood to the chest and breast area. In traditional CABG surgery, one internal mammary artery (usually the left) and one or more veins from the leg are used as grafts. In BIMA surgery, both internal mammary arteries are used to bypass blocked coronary arteries, providing superior long-term blood flow to the heart.

Why Is BIMA Used in Heart Surgery?

The internal mammary arteries are highly resistant to atherosclerosis (plaque buildup). Because of this, they remain open longer compared to vein grafts. Using both arteries increases the durability of bypass surgery and significantly improves long-term outcomes.

Key reasons surgeons choose BIMA include

1. Better long-term graft patency
2. Reduced need for repeat surgeries
3. Improved survival rates
4. Enhanced blood flow to the heart muscle

Treatment of BIMA Bypass Surgery

BIMA is not suitable for every patient. Careful patient selection is essential. Ideal candidates often include

1. Patients with multi-vessel coronary artery disease
2. Younger patients requiring long-lasting grafts
3. Patients without severe obesity
4. Non-diabetic or well-controlled diabetic patients
5. Patients with good chest wall anatomy

Patients with poorly controlled diabetes, severe obesity, or high risk of chest wound infection may not be ideal candidates due to increased surgical risks.

How Is BIMA Surgery Performed?

BIMA treatment is performed during Coronary Artery Bypass Grafting (CABG) under general anesthesia.

Step-by-Step Procedure

1. Chest Opening – The surgeon opens the chest through a median sternotomy.
2. Harvesting Arteries – Both internal mammary arteries are carefully dissected from the chest wall.
3. Bypass Creation – The arteries are connected beyond the blocked coronary arteries.
4. Heart Support – Surgery may be done on-pump (using a heart-lung machine) or off-pump (beating heart).
5. Closure – The chest is closed after ensuring proper blood flow through grafts.

Advanced techniques like skeletonized harvesting are often used to reduce chest wall complications.

Benefits of BIMA Treatment

BIMA offers several long-term advantages over conventional bypass methods

1. Superior Graft Longevity :- Internal mammary arteries can remain open for more than 20–25 years, significantly longer than vein grafts.
2. Improved Survival Rates :- Studies show better long-term survival in patients receiving BIMA compared to single internal mammary artery grafts.
3. Lower Risk of Repeat Procedures :- Because the grafts last longer, patients are less likely to need repeat bypass surgery or stenting.
4. Better Quality of Life :- Improved blood flow leads to reduced chest pain, increased exercise capacity, and better overall heart function.

Risks and Possible Complications

Although BIMA is safe in experienced hands, like all major surgeries, it carries certain risks

1. Wound healing problems in the chest
2. Infection, especially in diabetic patients
   
3. Bleeding
4. Irregular heart rhythms
5. Lung complications

Proper surgical technique and postoperative care significantly reduce these risks.

Recovery After BIMA Surgery

Recovery after BIMA surgery is similar to standard CABG recovery but may require careful wound care.

• Hospital Stay

1. ICU stay: 1–2 days
2. Total hospital stay: 5–7 days

• At-Home Recovery

1. Full recovery typically takes 6–12 weeks
2. Gradual return to daily activities
3. Cardiac rehabilitation is strongly recommended
4. Strict control of blood sugar in diabetic patients

Patients are advised to follow a heart-healthy diet, stop smoking, manage stress, and adhere to prescribed medications.

Long-Term Outcomes of BIMA Treatment

BIMA grafting is associated with

1. Long-term freedom from angina
2. Reduced cardiac events
3. Improved heart function
4. Higher patient satisfaction

Many patients continue to live active, symptom-free lives decades after surgery.

Conclusion

Treatment using BIMA (Bilateral Internal Mammary Artery) represents one of the most advanced approaches in coronary artery bypass surgery. By utilizing both internal mammary arteries, surgeons can offer patients longer-lasting grafts, improved survival, and a better quality of life. With proper patient selection, expert surgical technique, and comprehensive postoperative care, BIMA has become a preferred choice for long-term management of complex coronary artery disease. If you or a loved one has been advised to undergo bypass surgery, discussing the possibility of BIMA treatment with a cardiac surgeon can help you make an informed and confident decision.